Orthodontic appliance and method of using same during mixed dentition stage

ABSTRACT

A method and an orthodontic positioner for preventing or correcting overbite and/or overjet at a mixed dentition stage wherein a patient has permanent incisors and lost, unreplaced canine and deciduous molar teeth. A positioner essentially of a size for a person having incisors the same size as that of the patient but with a full set of permanent teeth (posteriorly to the permanent canine) is trimmed back posteriorly and along the gingival margins to fit in the patient&#39;s mouth without abrading the labial-buccal gum surfaces. This will concurrently provide depression of the incisors and guidance of eruption of the permanent canine and bicuspid teeth.

This application is a continuation-in-part of my earlier applicationSer. No. 626,267 filed Oct. 28, 1975 and is now abandoned.

BACKGROUND OF THE INVENTION

This invention relates to tooth positioning appliances, and inparticular it relates to the early treatment of overbite and overjetproblems.

In the field of orthodontics, at the point in time at which all of thedeciduous teeth have been replaced by permanent teeth, conventionalorthodontic devices such as bands or the like are often used forstraightening teeth to bring them to a predetermined position of properor close to proper occlusion. To bring teeth into a final position ofdesired orientation in the mouth, the orthodontists will often use atooth positioner, an example of which is shown in my earlier U.S. Pat.No. 3,898,736. The said patent relates to a preformed tooth positioner.However, custom-made positioners of this general type have also beenknown for many years, as illustrated for example in the Kesling U.S.Pat. No. 2,467,432.

A basic problem with these and other current orthodontic practices andequipment is that treatment does not commence until the stage is reachedat which all deciduous teeth have been replaced by their correspondingpermanent teeth, and this is so notwithstanding the fact that many realor potential orthodontic problems are recognizable at much earliertimes, for example upon eruption of the first permanent incisor teeth. Aparticular problem which can be recognized at such an early stage isoverbite and/or overjet.

Thus, it would solve a basic problem in the field of orthodontics andprovide a significant advance therein to provide procedures andequipment for commencing treatment of orthodontic problems during themixed dentition stage which precedes that stage at which all deciduousteeth have been replaced.

SUMMARY OF THE INVENTION

Thus, it is a purpose of the present invention to overcome the abovenoted shortcomings in the field of orthodontics by providing a methodand apparatus for treating orthodontic problems during the patient'smixed dentition stage.

This purpose of the present invention is achieved by redesigning andutilizing in a new way an orthodontic positioner of the type which isU-shaped in plan view and includes at least an upper or lower butnormally both upper and lower troughs including tooth receivingdepressions for receiving, retaining and repositioning the teethreceived therein.

The present invention is based on my realization that there exists, at acertain early stage in a child's orthodontic development, a situationsusceptible to effective treatment. Specifically, at an early age suchas from 6 to 8 or 9 all of a child's permanent incisor teeth have fullyerupted, after which a subsequent stage is reached at approximately ages10 through 12 during which the child loses the deciduous canine and thefirst and second deciduous molars, these teeth being ultimatelyreplaced, respectively, by the permanent canine, the permanent firstbicuspid and the permanent second bicuspid. This said subsequent stageoccurs at a time when the child also has in its mouth a permanent firstmolar (which erupts at about age 6, and hence they name "six yearmolar"). During this said subsequent stage, i.e. when the child has losteither the first or both of the deciduous molars and has eruptedpermanent incisors and a permanent first (six year) molar, which will bereferred hereinafter as the "subject stage", certain problems areclearly discernable, and of particular interest in this regard areproblems of overbite and overjet.

In accordance with the present invention, an orthodontic positioner ofthe type referred to above can be used in selective cases to correctsuch overbite and overjet. The result of this development is that apotential orthodontic problem is prevented from developing and convertedinto a perfect functional dentition. Basically, the concept is to use apositioner of the type described for depressing the incisor teeth whileconcurrently guiding the permanent bicuspids and permanent canine teethto their proper positions and controlling their vertical level oferuption. This technique has the significant advantage that thesituation can be perfected prior to the establishment of the interseptalperiodontal fibers and permanently control the vertical level of thepermanent teeth so that a difficult overbite problem in the permanentdentition is prevented from occurring.

This technique is particularly adaptable to selective cases. Thereshould be no potential mandibular or maxillary crowding, especially ofthe incisor teeth since such crowding constitutes a more serious problemwhich would require braces. Further, the situation is best adaptable toa Class I or an end-to-end relationship of the first permanent molarsbut would probably be inapplicable to a Class II relationship. A Class Irelationship means that the upper first permanent molar is at least onehalf tooth width rearwardly of the corresponding lower first permanentmolar. End-to-end of course means that the maxillary first permanentmolars are directly above their corresponding first mandibular permanentmolars. However, a class II relationship means that the maxillary firstpermanent molar is at least one half tooth width forward of itscorresponding first permanent mandibular molar, meaning that there willbe crowding of the anterior maxillary teeth to an extent which wouldrequire braces. Further, this technique can treat any degree of verticaloverbite but preferably the horizontal overjet should be no greater than3 to 4 millimeters.

The orthodontic positioner is basically of the type described in my saidearlier patent. However, to be functional in the present situation, thegingival edges of the labial-buccal flange of the positioner must beconsiderably cut back. The reason for this is not only that the youngerchild has a smaller mouth than the mouth of a patient for which apositioner of that type would generally be utilized, but also becausethe bone structure of the younger child is different. Specifically, thelabial-buccal sides of the gum protrude bucally a greater extentproportionally than would be the case for the same person having onlypermanent teeth since at the early stage prior to eruption of theposterior permanent teeth, such teeth are located down in the gum andnot necessarily on the center line of the teeth, but rather slightlybucally of center. Hence, in redesigning a positioner for use by a childin the mixed dentition stage having only permanent incisors and apermanent first molar, said cutting back of the positioner avoidsabrading the labial-buccal gum surfaces. The lingual flange is alreadycut back considerably so that it is not necessary to further cut backthis flange; and in any event there is not the same problem ofprotruding bone structure on the lingual side as exists on thelabial-buccal side. In addition, since a positioner of this type isnormally designed for receiving the teeth of a twelve year old child,the dentition of which includes a second permanent molar (which eruptsat approximately age 12 and hence the name, "twelve year molar"), andsince the subject patient in the present case is younger than this, thenthe rear portion of the positioner adapted to receive the secondpermanent molar can also be trimmed off.

Since the redesigned positioner of the present invention includes toothreceiving depressions for teeth which do not even exist, namely thepermanent canine and bicuspid teeth, the present invention isparticularly adapted for using a preformed positioner wherein suchdepressions already exist. The other type of positioner, the custom-madepositioner would be inapplicable because the depresssions therein arebased on impressions of existing teeth and do not normally includeestimates as to the size and shape of non-existing teeth. Of course onecould possibly make a custom positioner and guess as to the size andshape of the non-existent permanent canine and bicuspid teeth, and ifsuch guesswork were accurate, the present invention might possibly beadaptable for use with a custom positioner as well as a preformedpositioner.

As noted above, the mixed dentition stage also includes that earlierpoint in time when the child's permanent incisors and permanent firstmolars have erupted and the child has lost its deciduous canine teeth,its deciduous first molars, but the child has not lost its deciduoussecond molars. When the present invention is used at this earlier stage,the positioner will differ from that described above for the case whereboth deciduous molars have been lost. In this case wherein the seconddeciduous molars are still present, the depressions for the permanentsecond bicuspids, upper and lower, left and right, will each be replacedby a depression shaped and sized to receive the second deciduous molar.The lower second deciduous molars are about 2 mm wider than the lowerpermanent second bicuspids and the upper second deciduous molars areabout 1 mm wider than the upper permanent second bicuspids, saiddimensions taken in the mesio-distal (front to back) direction. Thedepressions for the first permanent molars must also be placed furtherback by that amount. In addition, there must be no interproximalprojections between the depressions for the first permanent molars andthe adjacent second deciduous molars so that when the second deciduousmolars are lost and the smaller second permanent bicuspids erupt intothe mouth, the first permanent molars can then drift forward to close upthe extra space.

Thus, it is an object of the present invention to provide for thetreatment of orthodontic problems at a point in time much earlier thanthe conventional commencement point for orthodontic treatment, and inparticular for providing treatment during the mixed dentition stage.

It is another object of this invention to provide a new and improvedmethod and device for early treatment of overjet and overbite problems.

It is still another object of this invention to provide an orthodonticmethod and device for controlling overbite and/or overjet by causingdepression of the permanent incisor teeth while guiding and controllingvertical eruption of the permanent canine and bicuspid teeth.

It is still another object of this invention to provide an orthodonticpositioner which is redesigned relative to a conventional orthodonticpositioner, especially by trimming back the gingival margins of thelabial-buccal flange, for fitting the mouth of a younger child whoseteeth are at the mixed dentition stage, especially to avoid abrading thetissues of the labial-buccal gum surfaces.

These and other objects and advantages of the present invention willbecome apparent from the detailed description to follow, together withthe accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

There follows a detailed description of a preferred embodiment of theinvention to be read together with the accompanying drawings in which:

FIG. 1 is a side elevational fragmentary view of a human mouth at onetype of mixed dentition stage and including maloccluded teeth in need oforthodontic treatment.

FIG. 1A is a cross-sectional view taken along line 1A--1A of FIG. 1.

FIG. 2 is a perspective view showing generally the upper surface of atooth positioner with a portion cut away to reveal a section of thelower surface thereof.

FIG. 3 is a fragmentary section view through a human mouth in the areaof the central incisors and showing the tooth positioner of FIG. 2 inplace therein.

FIG. 4 is a fragmentary section view through the human mouth in the areaof the permanent bicuspid teeth and showing the tooth positioner of FIG.2 in place therein.

FIG. 5 is a fragmentary section view of the human mouth in the molararea showing the tooth positioner of FIG. 2 in place therein.

FIG. 6 is a front elevational development view of FIG. 2 but on areduced scale.

FIG. 7 is a perspective view similar to FIG. 2 but wherein thepositioner has been appropriately trimmed in accordance with the presentinvention.

FIG. 8 is a front elevational development of FIG. 7 but on a reducedscale.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring now to the drawings, like elements are represented by likenumerals throughout the several views.

FIG. 1 is a view of the mouth 10 of a child at a type of mixed dentitionstage having permanent first molars 12a and 12b and permanent incisors,the right upper and lower lateral incisors 12c and 12d and the rightcenter upper and lower incisors 12e and 12f being shown in the figures.The space between the illustrated teeth is the area wherein deciduouscanine and molars have been lost but not yet replaced by theircorresponding permanent canine, first bicuspid and second bicuspidteeth. As is evident in FIG. 1, the permanent incisors illustrate apotential overbite and overjet problem, i.e. overbite meaning thevertical projection of the upper incisors below the plane of the top ofthe lower incisors and overjet meaning the horizontal distance betweenthe occlusal edges of the corresponding upper and lower incisors 12e and12f. In this case the permanent molars 12a and 12b abut each other inwhat is referred to as end-to-end relationship. The most desirable caseis that referred to as class I wherein the upper molar 12a is locatedrearwardly of the lower molar 12b by one half tooth width or more asrepresented by the dotted line I in FIG. 1. That case is preferablebecause it leaves the most room anteriorly thereof for the incoming andexisting permanent teeth. The end-to-end relationship is satisfactory inthat it still leaves sufficient room for the incoming teeth such that itis still possible to treat this type of mouth with the positioner inaccordance with the present invention. This would not be the case,however, with a class II situation wherein the upper molar 12a islocated forwardly of the lower molar 12b to the position represented bydotted line II.

Before discussing the application of the present invention for treatingthe mouth 10, reference is made to FIGS. 2 through 5 for a discussion ofthe structure and operation of the conventional preformed positioner asdiscussed in my said earlier patent.

Referring to FIGS. 2 through 5, and disregarding for the moment thedotted lines shown therein, these figures illustrate the conventionalorthodontic positioner. After the child has all of its permanent teethback to the second molar, conventional orthodontic devices such as bandsor the like are normally utilized for initial straightening of the teethin the mouth to bring the teeth into a predetermined position of properor close to proper occlusion. The positioner is then utilized to bringthe teeth into a final desired position. Such a retainer 20, as shown inFIG. 2, is generally U-shaped in plan so as to conform to typical humanmouth configuration and generally H-shaped in cross-section, providingan upper or superior tooth receiving trough 22 and a lower or inferiortooth receiving trough 24. The sides of the troughs 22 and 24 arebounded by lingual flange 26 which covers the rear of the teeth of theupper and lower arch and a labial-buccal flange 28 which cover the frontof the teeth of both arches.

Both the upper and lower tooth receiving surfaces 22 and 24 are providedwith a plurality of tooth receiving depressions or sockets, such as 22a,22b, 22c, 22d, 22e, and 22f, of different configurations for receivingthe different permanent teeth of the mouth from the central incisorsthrough the cuspids and bicuspids, into the first molar, and half of thesecond molar area. Alternatively, the positioner can of course be madehaving only an upper trough 22 or only a lower trough 24.

As best seen in FIGS. 3 through 5, the upper lingual flange 30, whichsecures the lingual cingulum areas of the upper anterior teeth andlingual surfaces of the lingual cusps of the upper posterior teeth,includes an inwardly directed rib 31 and covers a portion of the upperlingual gingival area 32, and the lower lingual flange 34 generallyembraces the cingulum area of the lower anterior teeth and the lingualsurface of the lingual cusps of the lower posterior teeth and includesan inwardly directed rib 35. This flange also extends over a portion ofthe lower lingual gingival tissue 36. The lower labial and buccal flange38 which covers the labial and buccal surfaces of the lower anterior andposterior teeth includes an inwardly directed rib 39 and also extendsover a portion of the lower labial and buccal gingival tissue 40 and theupper labial and buccal flange 42 has an inwardly directed rib 43 andcovers the entire labial and buccal surfaces of the upper anterior andposterior teeth and also embraces a small portion of the upper gingivaltissue 44.

The various pockets (such as 22a and 22b) in the positioner for theupper and lower teeth are made so that the teeth are snugly embracedthereby. The isthmus 46 which joins the lingual and buccal or labialhalves of the positioner is generally thin, though it differs indimension between the posterior region and anterior region so as toresemble the normal relaxed clearance between the teeth with theexception that the isthmus is slightly thinner in the posterior region.This enables all the occlusal and incisal surfaces of the teeth to be incontact with the positioner at the same time when occlusal pressure isapplied. Alternatively however, the thickness of the isthmus can bevaried to be increased in one of the anterior or posterior regionsrelative to other of said regions to cause either the anterior orposterior teeth to contact the isthmus before the other to correct foroverbite or open bite, respectively, as described in my copendingapplication Ser. No. 543,356, filed Jan. 23, 1975.

It has also been found that a preformed positioner of this type caninclude metal clasps imbedded in the rear portion thereof, as shown inU.S. Pat. Nos. 3,178,820 and 3,837,081, to more firmly secure thepositioner in place in the patient's mouth.

It has further been discovered that it is desirable to make the toothpositioner out of a semi-resilient plastic transparent material. Thetransparency enables the dental practitioner to actually see where thetooth movement will take place by observing blanching of tissue aroundthe teeth and also enables him to detect potential soft tissue sorespots due to abnormal impingement of the flanges of the toothpositioner.

Referring again to FIG. 1, and also to FIG. 1A, as noted above, thepresent invention seeks to provide a method and an apparatus fororthodontic treatment of teeth at an earlier than usual stage, namelythe mixed dentition stage as described above with respect to FIG. 1.This is accomplished by providing an orthodontic positioner soconstructed and arranged that the permanent incisor teeth 12c, 12d, 12e,and 12f will be depressed while the space between the incisors and thefirst permanent molar will be given vertical clearance to guide andcontrol eruption of the permanent canine and bicuspid teeth.

FIG. 1A illustrates a particular problem which exists in the mouth of achild at the mixed dentition stage. As is evident therein, the buccalgum tissues protrude significantly outwardly as represented at areas 60.The reason for this protrusion is that the not yet erupted permanentcanine and bicuspid teeth are located bucally of the illustrated firstmolars. Hence, a conventional orthodontic positioner designed for aperson having incisor teeth of the size as shown in FIG. 1 would not beoperable for performing the above described function in a mouth at themixed dentition stage as illustrated in FIGS. 1 and 1A. The main reasonfor this is that the outer margins of the labial-buccal flange of such apositioner would abrade the protruding labial-buccal gum surfaces,irritating the same, for example at the areas 60 of FIG. 1A. Inaddition, it is at least desirable if not absolutely necessary to trimback the portion of the conventional positioner provided for the secondmolar since there is no second molar in a child patient at the saidmixed dentition stage.

Referring now to FIGS. 2 through 6, there is illustrated thereon indotted lines the portions of the conventional positioner which wouldhave to be trimmed back in order to provide a positioner operable fortreating a child patient at said mixed dentition stage. Referring tothese figures, the labial-buccal flange is trimmed back along the upperportion thereof at line A, along the lower portion thereof at line B,and at the posterior end thereof to eliminate depression 22g of thesecond molar at line C. Except for this trimming back, it will beunderstood that the positioner will retain all of the structure andattendant advantages of the previously described preformed positioner.

FIGS. 7 and 8 illustrate the final trimmed back positioner ready for usein a patient at the mixed dentition stage.

In the case of treatment at the earlier point in time when the childstill has its second deciduous molars, the depressions 22e (top andbottom, both sides) would be altered as described earlier to fit thechild's second deciduous molars rather than the permanent secondbicuspids, and any interproximal projections between those depressions22e and adjacent depressions 22f for the first permanent molars would beeliminated.

Although the specific extent of the trimming back may depend on manydifferent factors, it has been found that the trim line A along theupper gingival edge of the labial-buccal flange should be such as totake off approximately 50 to 70 percent of the margin between the gumline and the outer margin of the labial-buccal flange in the region ofthe anterior teeth and approximately 70 to 90 percent of said distancebetween the gum line and the outer margin toward the upper posteriorteeth. The corresponding percentages for the lower trim line B would beapproximately 70 to 90 percent in the region of the anterior teeth andapproximately 110 to 120 percent in the area of the posterior teeth,i.e. at the posterior lower teeth it may be necessary to trim back theedge even occlusally of the gum line. The amount trimmed back can alsobe measured in terms of specific dimensions outwardly (i.e. gingivally)from the occlusal edges of the teeth. Such dimensions are given by wayof a preferred embodiment in the following Table I which gives thesedimensions as applied to an entire set of preformed positionerscurrently sold under the Registered Trademark Ortho-tain and which aredesigned to fit essentially the entire dental patient population. Hence,the set of positioners dimensioned as in Table I, provides a set ofpositioners adapted to fit a large percentage of the applicable dentalpatient population at said subject mixed dentition stage. Theexplanations of the columns of parts 1-4 of Table I are set forth inpart 5 of Table I and the sizes of the positioners in Table I correspondto those sold under the said Registered Trademark Ortho-tain, and asdescribed in my said U.S. Pat. No. 3,898,736.

In addition to Table I, Table II gives variations for Table I in thecase referred to above of treating a child who still has its seconddeciduous molars.

Table III provides a variation of the amount by which the gingival edgesare trimmed back in order to prevent damage to higher gums on youngchildren.

Although these Tables are applicable only to the non-extractionsituation, the invention is also applicable to serial-extraction caseswherein the first permanent bicuspids (upper and lower) are extractedprior to their eruption in the mouth. In this case the positioner designwould be similar to the non-extraction positioner of Table I with thesingle exception that the depressions for the first permanent bicuspidswould not be present, and all else would remain essentially the same.

                                      Table I                                     __________________________________________________________________________    (part 1)                                                                      Gross Dimensions Of Preformed Eruption Guidance Appliance In MM.              size                                                                             a  b  c  d  e   f   g   h   i   j                                          __________________________________________________________________________    1 G                                                                              16.5                                                                             12.0                                                                             9.0                                                                              14.6                                                                             35.4                                                                              53.2                                                                              22.5                                                                              14.0                                                                              13.4                                                                              12.9                                       11/2 G                                                                           16.8                                                                             12.3                                                                             9.2                                                                              14.9                                                                             36.4                                                                              54.2                                                                              23.2                                                                              14.1                                                                              13.7                                                                              13.0                                       2 G                                                                              17.0                                                                             12.6                                                                             9.3                                                                              15.2                                                                             37.5                                                                              55.1                                                                              24.0                                                                              14.3                                                                              13.9                                                                              13.1                                       21/2 G                                                                           17.3                                                                             12.8                                                                             9.5                                                                              15.5                                                                             38.5                                                                              56.1                                                                              24.7                                                                              14.4                                                                              14.2                                                                              13.2                                       3 G                                                                              17.6                                                                             13.1                                                                             9.7                                                                              15.8                                                                             39.6                                                                              57.0                                                                              25.4                                                                              14.6                                                                              14.5                                                                              13.2                                       31/2 G                                                                           17.9                                                                             13.4                                                                             9.8                                                                              16.1                                                                             40.6                                                                              58.0                                                                              26.1                                                                              14.7                                                                              14.7                                                                              13.4                                       4 G                                                                              18.2                                                                             13.7                                                                             10.0                                                                             16.5                                                                             41.6                                                                              59.0                                                                              26.9                                                                              14.9                                                                              15.0                                                                              13.6                                       41/2 G                                                                           18.5                                                                             14.0                                                                             10.2                                                                             16.8                                                                             42.7                                                                              60.0                                                                              27.6                                                                              15.0                                                                              15.3                                                                              13.7                                       5 G                                                                              18.7                                                                             14.2                                                                             10.4                                                                             17.1                                                                             43.7                                                                              60.9                                                                              28.3                                                                              15.2                                                                              15.6                                                                              13.8                                       51/2 G                                                                           19.0                                                                             14.5                                                                             10.5                                                                             17.4                                                                             44.8                                                                              61.8                                                                              29.1                                                                              15.3                                                                              15.8                                                                              13.9                                       6 G                                                                              19.3                                                                             14.8                                                                             10.7                                                                             17.7                                                                             45.8                                                                              62.8                                                                              30.8                                                                              15.5                                                                              16.1                                                                              14.0                                       __________________________________________________________________________

                  Table I                                                         ______________________________________                                        (part 2)                                                                      Gross Dimensions of Preformed                                                 Eruption Guidance Appliance In MM.                                            size k      l     m   n   o   p   q   r    s    t    u                        ______________________________________                                        G    8.8    8.7   2.5 7.3 5.9 7.1 6.1 4.3  2.2  3.3  9.0                      11/2 G                                                                             9.1    8.7   2.5 7.5 6.0 7.2 6.1 4.3  2.4  3.3  9.2                      2 G  9.3    8.7   2.5 7.6 6.1 7.3 6.2 4.3  2.5  3.3  9.4                      21/2 G                                                                             9.6    8.7   2.5 7.7 6.3 7.4 6.2 4.3  2.7  3.3  9.6                      3 G  9.9    8.7   2.5 7.9 6.4 7.5 6.3 4.3  2.9  3.3  9.8                      31/2 G                                                                             10.1   8.7   2.5 8.0 6.6 7.6 6.3 4.3  3.0  3.3  10.0                     4 G  10.4   8.7   2.5 8.2 6.7 7.7 6.4 4.3  3.2  3.3  10.2                     41/2 G                                                                             10.7   8.7   2.5 8.4 6.8 7.8 6.4 4.3  3.4  3.3  10.4                     5 G  11.0   8.7   2.5 8.5 6.9 7.9 6.5 4.3  3.6  3.3  10.6                     51/2 G                                                                             11.2   8.7   2.5 8.6 7.1 8.0 6.5 4.3  3.7  3.3  10.8                     6 G  11.5   8.7   2.5 8.8 7.2 8.1 6.6 4.3  3.9  3.3  11.0                     ______________________________________                                    

                                      Table I                                     __________________________________________________________________________    (part 3)                                                                      Gross Dimensions of Preformed Eruption Guidance Appliance in MM.                       d        a        vv       ww                                        size                                                                             aa                                                                              bb                                                                              cc                                                                              tot.                                                                             dd                                                                              ee                                                                              ff                                                                              tot.                                                                             gg                                                                              hh                                                                              ii                                                                              tot.                                                                             jj                                                                              kk                                                                              ll                                                                              tot.                                      __________________________________________________________________________    1 G                                                                              6.2                                                                             5.1                                                                             3.3                                                                             14.6                                                                             7.3                                                                             5.9                                                                             3.3                                                                             16.5                                                                             6.8                                                                             5.9                                                                             3.3                                                                             16.0                                                                             7.1                                                                             6.1                                                                             1.8                                                                             16.0                                      11/2 G                                                                           6.4                                                                             5.2                                                                             3.3                                                                             14.9                                                                             7.5                                                                             6.0                                                                             3.3                                                                             16.8                                                                             6.9                                                                             6.0                                                                             3.3                                                                             16.2                                                                             7.2                                                                             6.1                                                                             1.8                                                                             15.1                                      2 G                                                                              6.6                                                                             5.3                                                                             3.3                                                                             15.2                                                                             7.6                                                                             6.1                                                                             3.3                                                                             17.0                                                                             7.1                                                                             6.1                                                                             3.3                                                                             16.5                                                                             7.3                                                                             6.2                                                                             1.8                                                                             16.3                                      21/2 G                                                                           6.8                                                                             5.4                                                                             3.3                                                                             15.5                                                                             7.7                                                                             6.3                                                                             3.3                                                                             17.3                                                                             7.1                                                                             6.3                                                                             3.3                                                                             16.7                                                                             7.4                                                                             6.2                                                                             1.8                                                                             16.                                       3 G                                                                              7.0                                                                             5.5                                                                             3.3                                                                             15.8                                                                             7.9                                                                             6.4                                                                             3.3                                                                             17.6                                                                             7.2                                                                             6.4                                                                             3.3                                                                             16.9                                                                             7.5                                                                             6.3                                                                             1.8                                                                             16.6                                      31/2 G                                                                           7.3                                                                             5.5                                                                             3.3                                                                             16.1                                                                             8.0                                                                             6.6                                                                             3.3                                                                             17.9                                                                             7.3                                                                             6.6                                                                             3.3                                                                             17.2                                                                             7.6                                                                             6.3                                                                             1.8                                                                             16.7                                      4 G                                                                              7.6                                                                             5.6                                                                             3.3                                                                             16.5                                                                             8.2                                                                             6.7                                                                             3.3                                                                             18.2                                                                             7.4                                                                             6.7                                                                             3.3                                                                             17.4                                                                             7.7                                                                             6.4                                                                             1.8                                                                             15.9                                      41/2 G                                                                           7.8                                                                             5.7                                                                             3.3                                                                             16.8                                                                             8.4                                                                             6.8                                                                             3.3                                                                             18.5                                                                             7.6                                                                             6.8                                                                             3.3                                                                             17.7                                                                             7.8                                                                             6.4                                                                             1.8                                                                             16.0                                      5 G                                                                              8.0                                                                             5.8                                                                             3.3                                                                             17.1                                                                             8.5                                                                             6.9                                                                             3.3                                                                             18.7                                                                             7.7                                                                             7.0                                                                             3.3                                                                             17.9                                                                             7.9                                                                             6.5                                                                             1.8                                                                             16.2                                      51/2 G                                                                           8.2                                                                             5.9                                                                             3.3                                                                             17.4                                                                             8.6                                                                             7.1                                                                             3.3                                                                             19.0                                                                             7.8                                                                             7.1                                                                             3.3                                                                             18.2                                                                             8.0                                                                             6.5                                                                             1.8                                                                             16.8                                      6 G                                                                              8.4                                                                             6.0                                                                             3.3                                                                             17.7                                                                             8.8                                                                             7.2                                                                             3.3                                                                             19.3                                                                             7.9                                                                             7.2                                                                             3.3                                                                             18.4                                                                             8.1                                                                             6.6                                                                             1.8                                                                             16.8                                      __________________________________________________________________________

                  Table I                                                         ______________________________________                                        (part 4)                                                                      Gross Dimensions Of Preformed                                                 Eruption Guidance Appliance In MM.                                                                  xx               yy                                                                 zz                                                                            size mm nn oo tot. pp qq rr tot. ss tt uu tot.    ______________________________________                                        1 G  6.3    4.9   1.8 13.0 5.6 3.8 1.6 11.0 4.3 2.2 2.5                                                   9.0                                                                           11/2 G 6.3 5.0 1.8 13.1 5.7 3.9 1.6 11.2 4.3 2                                .4 2.5 9.2                                                                    2 G 6.4 5.1 1.8 13.3 5.7 4.0 1.6 11.3 4.3 2.5                                 2.5 9.3                                                                       21/2 G 6.5 5.1 1.8 13.4 5.8 4.1 1.6 11.5 4.3 2                                .7 2.5 9.5                                                                    3 G 6.6 5.2 1.8 13.6 5.9 4.2 1.6 11.7 4.3 2.9                                 2.5 9.7                                                                       31/2 G 6.6 5.3 1.8 13.7 5.9 4.3 1.6 11.8 4.3 3                                .0 2.5 9.8                                                                    4 G 6.7 5.4 1.8 13.9 6.0 4.4 1.6 12.0 4.3 3.2                                 2.5 10.0                                                                      41/2 G 6.8 5.5 1.8 14.1 6.1 4.4 1.6 12.1 4.3 3                                .4 2.5 10.2                                                                   5 G 6.9 5.6 1.8 14.3 6.2 4.5 1.6 12.3 4.3 3.6                                 2.5 10.4                                                                      51/2  G 6.9 5.7 1.8 14.4 6.2 4.6 1.6 12.4 4.3                                 3.7 2.5 10.5                                                                  6 G 7.0 5.8 1.8 14.6 6.3 4.7 1.6 12.6 4.3 3.9                                 2.5 10.7                                          ______________________________________                                    

Table I (part 5)

a. Greatest anterior vertical height (labial flange).

b. Vertical height through first pre-molar area (buccal-flange).

c. Vertical height through the first molar area in line with the centerof mesio-bucco cusp of the upper molar (buccal-flange).

d. Vertical height through the midline on the anterior surface (labialflange).

e. Gross length of the appliance through the midline to the lineperpendicular to it running tangent across the most posterior extents ofthe appliance.

f. Greatest width through the molar area.

g. Distance between lingual flanges at level of mesio-lingual cusps ofthe first permanent molars, (upper).

h. Width through the middle of the first upper molar area.

i. Width through the middle of the upper first pre-molar area.

j. Width through the mesial of the central incisors.

k. Height of the lingual flange at the midline.

l. Height of the lingual flange through the first pre-molar area.

m. Height of the most distal portion of the flange mid-way betwen thebuccal and lingual cusps of the first molar.

n. Height of the upper flange of the retainer from the incisal edge tothe flange in the upper arch.

o. Height of the lower flange from the incisal edge of the lower centralincisor to the edge of the margin of the retainer.

p. Height of the upper flange from the tip of the cusp of the uppercanine to the margin of the retainer.

q. Height of the lower flange from the tip of the lower cusp of thecanine to the margin of the retainer.

r. Height of the upper flange from the tip of the mesial buccal cusp tothe edge of the margin of the retainer.

s. Height of the lower flange from the tip of the mesial buccal cusp ofthe lower first molar to the margin of the retainer.

t. Freeway space at the midline or the distance from the tip of theincisal edge of the upper central incisor to the tip of the incisal edgeof the lower central incisor.

u. Height of lingual flange at the level of the center of the upper andlower central incisors or the greatest dimension of the retainer on thelingual at the level of the central incisors.

aa. Height of the upper flange of the retainer at the midline from theincisal edges of the central incisors.

bb. Height of the retainer margin of the lower portion of the retainerfrom the incisal edges of the lower central incisors to the lower marginof the retainer at the midline.

cc. Freeway space between the central incisors at the midline. cc isequivalent to the dimension t. d total is the same dimension as d.

dd. The height of the upper flange of the retainer as measured from thecenter of the incisal edge of the upper central incisor.

ee. The height of the lower flange of the retainer as measured from thecenter portion of the incisal edge of the lower central incisor.

ff. Represents the freeway space between the incisal edges of the upperand lower central incisors. a total is the same as No. a.

gg. The height of the upper flange of the retainer as measured from thecenter portion of the incisal edge of the upper lateral incisor.

hh. The height of the lower flange of the retainer as measured from thecenter of the incisal edge of the lower central incisor.

ii. Represents the freeway space as measured from between the incisaledges of the upper and lower lateral incisors. vv total represents thetotal distance between the upper and lower margins of the retainer atthe level of the lateral incisor.

jj. Represents the same as p.

kk. Represents the same as q.

ll. Represents the freeway space as measured between the tips of thecusps of the upper and lower canines. ww total represents the totalheigt between the margins of the retainer at the level of the canine.

mm. Represents the height of the margin of the retainer as measured fromthe tip of the buccal cusp of the upper first bicuspid tooth.

nn. Represents the height of the lower flange of the retainer at thelevel of the tip of the cusp of the lower first bicuspid. (buccal cusp).

oo. Represents the freeway space at the level of the first bicuspid asmeasured between the tips of the cusps (buccal) of the upper and lowerfirst bicuspids

pp. Represents the height of the upper flange of the retainer at thelevel of the upper second bicuspid as measured from the tip of thebuccal cusp to the margin.

qq. Represents the height of the lower flange of the retainer asmeasured from the tip of the buccal cusp of the lower second bicuspid.

rr. Represents the freeway space at the level of the second bicuspid asmeasured between the tips of the buccal cusps of the upper and lowersecond bicuspids.

ss. Represents same as r.

tt. Represents same as s.

uu. Represents same as m.

d total. Represents the total of aa+bb+cc, or the same d.

a total. Represents the total of dd+ee+ff, or the same as a.

vv total. Represents the total of gg+hh+ii, or the vertical height ofthe retainer at the level of the lateral incisors on the labial.

ww total. Represents the total of jj+kk+ll, or the vertical labialheight of the retainer at the level of the canine.

xx total. Represents the total of mm+nn+oo, or the vertical buccalheight of the retainer at the level of the first bicuspid.

yy total. Represents the total of pp+qq+rr, or the vertical buccalheight of the retainer at the level of the second bicuspid.

zz total, Represents the total of ss+tt+uu, or the vertical buccalheight of the retainer at the level of the first permanent molar, orsame as c.

                                      Table II                                    __________________________________________________________________________    Dimensions Of The Deciduous 2nd Molars And Arch Widths Of Position Of 1st     -Permanent Molars For Occlus-O-Guide                                               Upper  Lower  Arch-Width                                                      2nd Dec.                                                                             2nd Dec.                                                                             Between  Arch-Width                                             Molar  Molar  Mesio-Buccal                                                                           of Lower                                          Size Mesio-Distal                                                                         Mesio-Distal                                                                         Cusps of Upper                                                                         1st Perm.                                         Occlus-o-                                                                          Dimension                                                                            Dimension                                                                            1st Perm.Molars                                                                        Molars Free-Way                                   Guide                                                                              mm.    mm.    mm.      mm.    Space                                      __________________________________________________________________________    1 G  7.76   8.48   47.0     42.7   2.7                                        11/2 G                                                                             7.94   8.68   47.9     43.5   2.8                                        2 G  8.13   8.88   48.8     44.3   2.9                                        21/2 G                                                                             8.31   9.08   49.6     45.0   3.0                                        3 G  8.49   9.28   50.5     45.8   3.1                                        31/2 G                                                                             8.68   9.48   51.4     46.7   3.2                                        4 G  8.86   9.68   52.3     47.5   3.3                                        41/2 G                                                                             9.04   9.88   53.2     48.3   3.4                                        5 G  9.23   10.08  54.0     49.0   3.5                                        51/2 G                                                                             9.41   10.28  54.9     49.8   3.6                                        6 G  9.59   10.48  55.8     50.6   3.7                                        __________________________________________________________________________

                  Table III                                                       ______________________________________                                        Occlus-O-Guide                                                                Distances From Incisal Edges To Gingival Margins                                                                          Up-                                    Lower    Lower           Upper  Upper  per                                    Central  Lateral  Lower  Central                                                                              Lateral                                                                              Can-                                   Incisors Incisors Canines                                                                              Incisors                                                                             Incisors                                                                             ines                              Size mm.      mm.      mm.    mm.    mm.    mm.                               ______________________________________                                        1    3.8      3.1      5.1    5.5    4.7    4.7                               11/2 4.1      3.4      5.2    5.8    4.8    4.9                               2    4.4      3.7      5.4    6.1    4.9    5.1                               21/2 4.7      4.0      5.5    6.4    5.0    5.3                               3    5.0      4.3      5.7    6.7    5.1    5.5                               31/2 5.3      4.6      5.8    7.0    5.2    5.7                               4    5.6      4.9      6.0    7.3    5.3    5.9                               41/2 5.9      5.2      6.1    7.6    5.4    6.1                               5    6.2      5.5      6.3    7.9    5.5    6.3                               51/2 6.5      5.8      6.4    8.2    5.6    6.5                               6    6.8      6.1      6.6    8.5    5.7    6.7                               ______________________________________                                    

The orthodontists would utilize the positioner of the present inventionin accordance with the following procedure. He would take a measurementof the area that would be occupied by the upper four incisor teeth and aproper size non-extraction preformed positioner is selected. If aconventional preformed positioner is used, the gingival tissues must betrimmed back, as described above so that the positioner does not abradethe widely outwardly tapering gingival areas 60. Alternatively, if thepositioners are provided already trimmed back a proper amount, forexample, as in Table I, the orthodontist would use said measurement toselect the proper size pre-trimmed positioner. Normally the positionerwould then be worn for approximately 3 to 4 hours a day with exercising(clenching and holding the teeth in the clenched position) and at nightduring sleep. When the overbite is corrected, the daytime wear can becut down to one hour per day and at night. The positioner should thenpreferably be used until all of the permanent bicuspid and canine teethhave fully erupted.

Although the invention has been described in considerable detail withrespect to a preferred embodiment thereof, it will be apparent that theinvention is capable of numerous modifications and variations apparentto those skilled in the art without departing from the spirit and scopeof the invention.

I claim:
 1. A method of positioning teeth comprising the stepsof:providing an orthodontic positioner of the type which is generallyU-shaped in plan view and includes in at least one of the top or bottomthereof a tooth receiving trough for receiving and positioning teeth,said providing step comprising selecting a preformed positioner havingin the trough or troughs therein at least depressions of a size andshape for a subject patient having permanent incisor teeth, permanentcanine teeth and permanent first bicuspid teeth and having a dimensionacross the front of the depressions of the incisor teeth equal to thedimensions across the front incisor teeth of the subject patient,applying the positioner for use by a patient at a mixed dentition stageof development wherein the patient has permanent incisors and permanentfirst molars, and wherein the deciduous canine and at least the firstdeciduous molars are absent and have not yet been replaced by thecorresponding permanent canine and bicuspid teeth by applying the saidselected preformed positioner to the patient's teeth, such usecontinuing for at least a portion of the time from the initialapplication of the positioner to the time that said permanent canine andbicuspid teeth have fully erupted, whereby such use causes earlydepression of the incisor teeth while permitting unhindered eruption ofthe said permanent canine and bicuspid teeth.
 2. The method of claim 1,wherein said providing step includes providing a positioner having toothreceiving troughs in both the top and bottom thereof.
 3. The method ofclaim 1, said applying step comprising applying the positioner for useuntil the permanent canine and bicuspid teeth are fully erupted.
 4. Themethod of claim 1, wherein said selecting step includes selecting apositioner designed for a person having all permanent teeth from thefirst permanent molars, anteriorly thereof, and trimming back thegingival marginal edges of the labial-buccal flange thereof to adistance to prevent said margins from abrading the labial-buccal gumsurfaces.
 5. The method of claim 4, said trimming back includingtrimming back at least 50 percent of the part of the labial-buccalmargin from the gum line to the outer gingival margin thereof.
 6. Themethod of claim 5, said trimming back including trimming back to atleast 70 percent of the part of the margin from the gum line to theouter gingival edge thereof adjacent the depressions for the firstpermanent molar.
 7. The method of claim 5, said trimming back includingeliminating part of the positioner containing the depressions for thesecond permanent molars.
 8. The method of claim 1, said providing stepfurther comprising measuring selected dimensions of the patient's mouthand based on such measurements selecting a preformed positioner havinggingival margins previously trimmed back to avoid abrading thelabial-buccal gum surfaces.
 9. The method of claim 8, wherein saidselecting step includes selecting a positioner from the set as describedin Table I.
 10. The method of claim 1, said providing step includingselecting a preformed positioner having in the trough or troughs thereofdepressions of a size and shape for a person having permanent teeth fromthe first permanent molar and anteriorly thereof except for the seconddeciduous molars which are present rather than the second permanentbicuspids, and said applying step including applying the positioner to apatient having second deciduous molars in place and only the firstdeciduous molars out and unreplaced.
 11. The method of claim 10, whereinthe selecting step includes selecting a positioner from the set asdescribed in Table I, as modified by Table ble II.
 12. The method ofclaim 10, wherein said providing step includes providing a positionerhaving tooth receiving troughs in both the top and bottom thereof. 13.The method of claim 10, said applying step comprising applying thepositioner for use until the permanent canine and bicuspid teeth arefully erupted.
 14. The method of claim 10, said providing step furthercomprising measuring selected dimensions of the patient's mouth andbased on such measurements selecting a preformed positioner havinggingival margins previously trimmed back to avoid abrading thelabial-buccal gum surfaces.
 15. An orthodontic positioner of the typewhich is generally U-shaped in plan view and includes a tooth receivingtrough in at least one of the upper or lower sides thereof, which troughincludes tooth receiving depressions for receiving and positioningteeth,said positioner including depressions for at least the permanentincisors, permanent cuspids, at least the first permanent bicuspids andthe permanent first molar teeth of a given person, and wherein thegingival margins of the labial-buccal flange of the positioner aretrimmed back relative to the labial-buccal flange of a positionerdesigned for a said given person having all permanent teeth from thefirt permanent molars and anteriorly thereof to at least 50 percent ofthe original distance from the gingival edge of the gum line, so as notto abrade the labial-buccal gum surfaces of a patient having permanentincisors and a permanent first molar of the same size as said givenperson but also having lost, unreplaced deciduous canine and at leastthe first deciduous molars.
 16. An orthodontic positioner according toclaim 15, said positioner extending posteriorly only to the firstpermanent molar.
 17. An orthodontic positioner according to claim 15,wherein the gingival margins are trimmed back to at least 70 percent ofthe original distance from the gum line to the gingival margin in thevicinity of the posterior teeth.
 18. An orthodontic positioner accordingto claim 15, having dimensions as set forth in Table I.
 19. A set oforthodontic positioners, each constructed according to claim 15, andhaving dimensions as set forth in Table I.
 20. An orthodontic positioneraccording to claim 15, said positioner having depressions for allpermanent teeth from the first permanent molars inclusive, anteriorlythereof.
 21. An orthodontic positioner according to claim 20, saidpositioner extending posteriorly only to the first permanent molar. 22.An orthodontic positioner according to claim 15, said positioner havingdepressions for all permanent teeth from the first permanent molarsanteriorly thereof except for the location of the permanent secondbicuspids at which there is provided instead depressions for the seconddeciduous molars.
 23. An othodontic positioner according to claim 23,said positioner being free of interproximal projections between theadjacent recesses for the first permanent molar and the second deciduousmolar.
 24. An orthodontic positioner according to claim 23, including aset of positioners dimensioned as set forth in Table I, as modified byTable II.
 25. An orthodontic positioner according to claim 23, saidpositioner extending posteriorly only to the first permanent molar. 26.An orthodontic positioner according to claim 23, wherein said gingivalmargins are trimmed back to at least 50 percent of the orginal distancefrom the gingival edge to the gum line.
 27. An orthodontic positioneraccording to claim 15, said positioner having tooth receiving troughs inboth the top and the bottom thereof.
 28. An orthodontic positioner ofthe type which is generally U-shaped in plan view and includes a toothreceiving trough in at least one of the upper or lower sides thereof,which trough includes tooth receiving depressions for receiving andpositioning teeth,said positioner including depressions for at least thepermanent incisors, permanent cuspids, at least the first permanentbicuspids and the permanent first molar teeth of a given person, andwherein the labial-buccal flange of the positioner extends no fartherthan the vicinity of the gingival edges of the tooth receivingdepressions, so as to preclude abrading the labial-buccal gum surfacesof a patient having permanent incisors and a permanent first molar ofthe same size as said given person but also having lost, unreplaceddeciduous canine and at least the first deciduous molars.
 29. Anorthodontic positioner according to claim 28, including both upper andlower troughs.
 30. An orthodontic positioner according to claim 28,including only an upper trough.
 31. A set of orthodontic positioners,each constructed according to claim 28, the positioners of the sethaving dimensions as set forth in Table I.
 32. A set of orthodonticpositioners, each constructed according to claim 28, the positioners ofthe set dimensioned as set forth in Table I, as modified by Tables IIand III.
 33. An orthodontic positioner according to claim 28, saidpositioner having depressions for all permanent teeth from the firstpermanent molars inclusive, anteriorly thereof.
 34. An orthodonticpositioner according to claim 33, said positioner extending posteriorlyonly to the first permanent molar.
 35. An orthodontic positioneraccording to claim 28, said positioner having depressions for allpermanent teeth from the first permanent molars anteriorly thereofexcept for the location of the permanent second bicuspids at which thereis provided instead depressions for the second deciduous molars.
 36. Anorthodontic positioner according to claim 35, said positioner being freeof interproximal projections between the adjacent recesses for the firstpermanent molar and the second deciduous molar.